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Late Effects

Second Malignant Neoplasm


Bone Marrow Transplant


The cumulative incidence of risk a second cancer after BMT is about 5 - 12%.

Children - especially if they are less than 5 years old at the time of transplant, have a 50X risk over the general population of developing a second neoplasm.

The cumulative risk of developing a second cancer increases with age.

Risk is due to a combination of:

  • Immunosuppression
  • Exposure to radiation therapy (RT)
  • Exposure to high dose chemotherapy


Types of cancer seen:

Tumors occur which are typically associated with immunodeficiency

  • Lymphomas:
    • EBV post transplant lymphoproliferative disease common (EBV-PTLPD)
    • Incidence very increased in children with underlying immunodeficiency
    • Most PTLPD is B-cell in origin
  • Squamous cell cancers of skin are very common:
    • Virus associated cancers are seen - for example squamous cell cancers of the skin, cervix and anus (associated with papilloma virus)
  • Other Epithelial cancers:
    • RT and chemotherapy causes DNA damage and an increased risk for epithelial cancers (such as thyroid cancer)
  • Renal cancers:
    • Reduced cellular immunity increases the risk of tumors such as renal cancer
  • Leukemias/MDS:
    • Due to DNA damage and associated with immunosupression


The prognosis for patients who develop a second cancer after BMT is generally very poor with a median survival of less than 2 years.



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